Hernia and Hernia Surgery: All Information for Bangladeshi Patients

What is a Hernia?

When abdominal contents like intestine or fat protrude through a weak point of the abdominal wall or groin, it is called a hernia. It appears as an abnormal swelling on standing, coughing, or exercise, and disappears after sleeping. Actually, it causes mild discomfort when reduced spontaneously, but when content becomes irreduced, there may be a change in impairment of the vascularity of the intestine.

Common Types of Hernia

1. Inguinal Hernia: A hernia that occurs in the groin. Inguinal hernia is common in males. Both the young and elderly groups. Those who have a history of smoking, heavy weight carrying, asthma, or prostatic disorder. A congenital type of inguinal hernia is common in children and young adults. It can recur if predisposing factors can't be corrected
   
2. Ventral Hernia: Occurs through the anterior abdominal wall. divided into
3. Umbilical Hernia: Common in females after cesarean section 
4. Epigastric Hernia: Often confused with epigastric lipoma
5. Spigelian Hernia: Through the lateral border of the rectus. Rarely found
6. Incisional Hernia: Through the previous surgery scar. It is very common after emergency surgery.
7. Hiatus Hernia: in the chest wall through an abnormal gap in the diaphragm.
8. Femoral hernia: A femoral hernia is a bulge of intestine or fat situated next to the femoral artery, in the lower part of your groin.

Symptoms of a Hernia

The symptoms of a hernia depend on its type and location. In general, a hernia occurs when an internal organ or tissue pushes through a weak spot in the surrounding muscle or connective tissue.

Inguinal Hernia: mostly male patients complain of groin swelling that appears when standing or coughing but reduces when lying down. Occasionally, complaints of pain.

Incisional Hernia: A hernia at the ventral aspect of the abdomen at a previous scar of surgery. The patient complained of pain and difficulty in breathing and walking.

Umbilical Hernia: present with umbilical swelling. Occasional pain, vomiting, and difficulty in movement.

Hiatus Hernia: difficulty in swallowing. Salivation, but every hernia, when strangulated or obstructed, then complaints of severe pain, abdominal distention, and vomiting (features of intestinal obstruction).

Causes and Risk Factors of Hernia

Congenital Causes

• Occur when the peritoneal communication fails to close naturally after birth.
• Leads to a weak spot in the abdominal wall present since birth.

2. Lifestyle and Environmental Factors

• Cigarette smoking – damages collagen and weakens connective tissue, increasing hernia risk.
• Carrying or lifting heavy weights – raises intra-abdominal pressure, straining the abdominal muscles.

3. Conditions That Increase Abdominal Pressure

• Chronic constipation – frequent straining during bowel movements.
• Chronic cough from asthma or obstructive airway disease.
• Prostate enlargement – causes straining during urination, leading to pressure buildup in the abdomen.

4. Age-Related Factors

Elderly individuals are more prone due to:

• Laxity (weakening) of abdominal muscles.
• Prostate enlargement contributing to increased abdominal strain.

People who carry a heavy weight, cigarette smokers, which damages collagen fibers of the body, elderly people due to laxity of the body wall, people with constipation, people with asthma or pulmonary airway problems, people with benign enlargement of the prostate, and people with congenital hernia in young people.

Diagnosis of Hernia

• Most of the patients are diagnosed clinically by cough impulse and reducible test on OPD.
• In children, a hernia appears when they cry. So, sometimes it needs the help of photography by parents when they cry.
• We prescribed an investigation to diagnose predisposing factors, for example, USG to diagnose prostatic enlargement.
• When we plan surgery, we advise a fitness investigation.

Treatment option for Hernia 

All patients with a hernia can be treated in two ways

1. Laparoscopic surgery 

A minimally invasive procedure performed through small incisions. A laparoscope (camera) and specialized surgical instruments are used to repair the hernia. Smaller scars and faster recovery, Less postoperative pain, Shorter hospital stay.

2. Open surgery 

Involves making a single larger incision over the hernia site. The surgeon pushes the protruding tissue back and reinforces the abdominal wall using sutures or a mesh. Effective for large or recurrent hernias, Suitable for patients not fit for laparoscopy.

We prescribed these options according to: 

• Proper patient selection 
  
• Patient's fitness 
• Patient's preference 
• Patient's economic condition 
• Availability of facilities.

For example, we suggest laparoscopic surgery for an elderly male patient. But he has obstructive airway disease. In that case, we have to choose open surgery over laparoscopic surgery. Otherwise, a healthy, fit patient can choose laparoscopic surgery.

If a patient's fitness is satisfactory, then hernia surgery, whether performed using the open or laparoscopic technique, is considered safe.

Inguinal Hernia Surgery:

Inguinal hernia surgery can be performed using either an open or a laparoscopic technique. In open surgery, we make an incision in the inguinal region, identify the hernial sac, make a dissection, and then place a mesh to strengthen the abdominal wall.

-In the laparoscopic technique, we make only 3 small ports and perform the procedure.

We can start feeding the patient after six hours of operation if the patient's vitals allow. First, we give liquid confidence, then gradually give semisolids and solids. We advised the patients to avoid food that caused constipation and cough

Complications of Hernia Surgery

The treatment option for a hernia is always surgery. If the patient doesn’t receive adequate treatment, then the possibilities are serious complications such as obstruction, strangulation, and gangrene of the herniated tissue, which can become life-threatening and require emergency surgical intervention. 

• Intestinal obstruction – abdominal distension, vomiting, pain.
• Strangulation – vascularity of the intestine is impaired. Severe pain in the whole abdomen. Features of shock develop.
• Perforation of the intestine – this is a surgical emergency. The patient may die if there is a delay in getting treatment.

The operations that are performed

Open or endo-laparoscopic hernia repair, with or without mesh

Hernia Surgery Cost in Bangladesh

The cost of hernia surgery varies depending on the type of hernia and the surgical approach used. Generally, laparoscopic surgery is more expensive than open surgery due to the advanced equipment and expertise required.

Complications After Hernia Surgery

While hernia surgery is generally safe and effective, certain complications may occur, especially after open surgery. These complications can vary depending on the patient’s health, the type of hernia, and postoperative care.

• Hematoma Formation: accumulation of blood in the operative zone
• Seroma formation: accumulation of fluid due to lipolysis
• Wound infection: pus formation in the operative zone
• Recurrence: if predisposing factors are not corrected
• Mesh Rejection: A rare complication where the body’s immune system reacts negatively to the surgical mesh used for hernia repair.

But all the above complications do not occur when operations are performed laparoscopically.

Recovery Time and Aftercare of Hernia

Recovery Time

Laparoscopic Surgery: Most patients recover within 2 days and can return to light activities soon after.

Open Surgery: Recovery usually takes about 1 week, depending on the patient’s overall health and the size of the hernia.

Aftercare

• Abdominal binder for 3 months,
• Not carry weight for 3 months
• Treatment of constipation, COPD, and prostatic enlargement.

Prevention Tips for Hernia

As the saying goes, “Prevention is better than cure.” Taking the right precautions can significantly reduce the risk of developing a hernia or prevent recurrence after surgery.

• Stop smoking 
• Treatment of respiratory disorder 
• Treatment of constipation 
• Treatment of Prostatic Disorder 
• Avoid extra weight-bearing
• After any abdominal surgery, apply an abdominal binder
• If any infection occurs after surgery, proper treatment of the infection.

Conclusion

Hernia is a common but treatable condition that should never be ignored. With timely diagnosis and proper surgical management—either through laparoscopic or open surgery—most patients can expect a full recovery and return to normal activities. Following postoperative care, maintaining a healthy lifestyle, and addressing factors such as constipation, smoking, and chronic cough are essential to prevent recurrence.

Early consultation with a qualified surgeon ensures the best outcome and helps avoid serious complications like obstruction, strangulation, or gangrene.

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